Out-of-Hospital Cardiac Arrests Increase During COVID-19 Pandemic


Further investigation needs to be done to determine whether this increase is due to the effects of lockdowns or the virus itself.

Adrienne Nickles, MPH

New research highlights the marked increase in out-of-hospital cardiac arrests and fatalities in the metropolitan Detroit area due to the coronavirus disease 2019 (COVID-19) pandemic.

Since March 10, 2020, around 360,449 positive COVID-19 cases have been recorded in Michigan. Of that total, nearly 33% of cases have come from the Detroit metro area, which includes Macomb, Oakland, and Wayne Counties and represents a population of 3.9 million.

A team led by Adrienne Nickles, MPH, Lifecourse Epidemiology and Genomics Division, Michigan Department of Health and Human Services, Lansing, used data from the Michigan EMS Information System to determine whether out-of-hospital cardiac arrests attended by emergency medical services in high-burden areas increased over the past year.

The Findings

Nickles and team compared data from 2019 with 2020.

Between March 23 and May 31, 2019, they identified 1162 out-of-hospital cardiac arrest calls. Of these calls, 451 (38.8%) out-of-hospital cardiac arrests occurred in individuals aged 65-84 years old, 662 (57.0%) occurred in men, and 626 (53.9%) occurred in White individuals.

In 2020, within this same time period, 1854 out-of-hospital cardiac arrest calls were identified. Further, 735 (39.6%) out-of-hospital cardiac arrest calls occurred in individuals aged 65-84 years, 1084 (48.5%) occurred in men, and 867 (46.8%) occurred in White individuals.

“The 1854 out-of-hospital cardiac arrest calls during the pandemic period studied (March 23 through May 31, 2020) represent a 60% increase compared with 1162 out-of-hospital cardiac arrest calls during the same period in 2019,” write Nickles and colleagues.

They noted that out-of-hospital cardiac arrests increased across all demographic characteristics in 2020, including age, race, location, and presumed causes, but with greater disproportionate skew among those ≥85 years old (2020: 341 cases [18.4%] vs 2019: 171 [14.7%]; P = .01) and black individuals (2020: 724 cases [39.1%] vs 2019: 353 [30.4%]; P<.001).

Furthermore, the findings noted that a greater proportion of cases occurred at nursing facilities in 2020 (407 cases [22.0%]) than in 2019 (219 [18.8%] in 2019; P = .03). 

And finally, the proportion of deaths following out-of-hospital cardiac arrest calls increased by 42% in 2020 (1400 patients [75.5%] vs 619 [53.3%] in 2019; P < .001).


The investigators noted that their study considered only prehospital records, among other limitations.

“Definitive causes of death are not known and it is not clear from these data whether the increase arose as a direct effect of COVID-19 infection or from indirect effects of the pandemic on utilization of EMS,” they wrote.

“Further investigation is needed to characterize the phenomena underlying these associations to design interventions to mitigate the impacts of the ongoing COVID-19 pandemic.”

The study, “Comparison of Out-of-Hospital Cardiac Arrests and Fatalities in the Metro Detroit Area During the COVID-19 Pandemic With Previous-Year Events,” was published online in JAMA Network Open.

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